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[NYENTORT RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Naso: —Z M"1 0,-10/ NoC& �r4 <br />Facility Address: 11/ O e Q I-oa KGC <br />Telephone : hof 9 /— 7-57-xV <br />Person Filing '4/ <br />Report �Io% . /vu Nn vwok/ <br />APR 0 6 1992 <br />ENVIRONME-iVTAL HEALTH <br />PERMIT/S€RVIC€P <br />Tank I Size Product <br />m Oo <br />z so <br />IO /N`l <br />I hereby certify under penalty of perjury that all inventory variations for <br />Che above mentioned facility were within the allowable limits for this <br />quarter. (He in Column 13 of the LovenCory Reconciliation Sheet) <br />❑ Iaveatocy vaciatioas exceeded the allowable limit■ for thin quarter. i <br />hereby certify under penalty of perjury that the source for the variation <br />van aoC due Co as unauthorized (leak) celeste. (Yen is Column 13 of the <br />Inventory Reconciliation Sheet) <br />+ <br />List date. tank i. and aswaat for all variaCious Chat exceeded the <br />allowable IiniCa_ <br />Date Tank I Amount <br />Additional dates/aaaoaats shall be coatioued on a aeparate sheet of <br />paper and attached - <br />If the source of the variation which. exceeded allowable limits was due to <br />a leak the incident shall be reported to S.J_L.H.D. Environmental llcalch <br />within 24 hours and an unauthorized release report submitted - <br />The qu rtcrly summary report shall be submitted within 15 days of the end of each <br />Quarte - <br />arccr I - January --) March <br />Q•.arccr 2 - April <br />Quarter ) - July --> Scpcemhcr <br />Q:.arcer 4 - October --> Dccember <br />Send to: SAN JOAQUIN LOCAI. HEA1.1.1i DISTRICT <br />L601 E. I!azc•It.ut, I'_0. ftrtx 2009 <br />S(ockton, CA 95201 466-67b1 <br />40 10/H6 <br />